Hypoglycaemia human insulin

Teuscher A, Berger WG. Hypoglycaemia unawareness in diabetics transferred from beef/porcine insulin to human insulin. Lancet 1987 2(8555) 382—5. 

Ferguson SC, Strachan MW, Janes JM, Frier BM. Severe hypoglycaemia in patients with type 1 diabetes and impaired awareness of hypoglycaemia a comparative study of insulin lispro and regular human insulin. Diabetes Metab Res Rev 2001 17(4) 285-91. 

Where aiumal insulins are still in use, change to a highly purified pork or human insulin may be successful in reducing resistance. Responsiveness to insulin may sometimes be restored by immunosuppression, e.g. an adrenocortical steroid (prednisolone 20-40 mg/d) over weeks (or a few months), to suppress antibody production. Obviously, if this is successful, insulin dosage will have to be reduced in accordance with the impredictable reduction in cmtibodies. Patients need to be carefully monitored to avoid severe hypoglycaemia. Ketoacidosis also reduces the effect of insulin. 

McNally PG, Nelson G, Fitch M. Patients with Type 2 diabetes mellitus have lower rates of nocturnal hypoglycaemia on biphasic insulin aspart (BIAsp30) than on biphasic human insulin-30 (BHI30) data from the REACH study. Diabetologia 2004 47 A327. 

When compared with soluble insulin, the human analogue insulin aspart has a faster onset and a shorter duration of action, resulting in a higher fasting and preprandial blood glucose concentration. The incidence of hypoglycaemia tends to be lower with insulin aspart than with soluble insulin. 

Colagiuri S, Miller JJ, Petocz P. Double-blind crossover comparison of human and porcine insulins in patients reporting lack of hypoglycaemia awareness. Lancet 1992 339(8807) 1432-5. 

George E, Bedford C, Peacey SR, Hardisty CA, Heller SR. Further evidence for a high incidence of nocturnal hypoglycaemia in IDDM no effect of dose for dose transfer between human and porcine insulins. Diabet Med 1997 14(6) 442—8. 

Airey CM, Williams DR, Martin PG, Bennett CM, Spoor PA. Hypoglycaemia induced by exogenous insulin— human and animal insulin compared. Diabet Med 2000 17(6) 416-32. 

The combined effect of p-CyD with absorption enhancers such as sodium glycocholate or Azone on the nasal absorption of human fibroblast interferon-p in powder form in rabbits has been described. HP-p-CyD was useful as a biocompatible solubilizer for lipophilic absorption enhancers involved in the nasal preparations of peptides. When insulin was administered nasally to rats, simultaneous use of an oily penetration enhancer, HPE-101, (l-[2-(decylthio)-ethyl]azacyclopentane-2-one) or oleic acid solubilized in HP-P-CyD showed a marked increase in serum immuno-reactive insulin levels and marked hypoglycaemia (Fig. 38.10). The potentiation of the enhancing effect of HPE-101 by HP-P-CyD can be explained by the facilitated transfer of HPE-101 into the nasal mucosa. Studies on the release of membrane proteins and scanning electron-microscopic observations of rat nasal mucosa indicated that the local mucosal damage due to the combination with HP-P-CyD may not be serious obstacles to their safe use. 

Not fully established. An in vitro study using human liver microsomes indicated that erythromycin inhibits the metabolism (mono-A-dealkylation) of disopyramide which, in vivo, would be expected to reduce its loss from the body and increase its serum levels. Clarithromycin and azithromycin probably do the same. The increased serum levels of disopyramide can result in adverse effects such as QT prolongation and torsade de pointes, and may result in enhanced insulin secretion and hypoglycaemia. - Both intravenous erythromycin and clarithromycin" alone have been associated with prolongation of the QT interval and torsade de pointes. Therefore, disopyramide and macrolides may have additive effects on the QT interval in addition to the pharmacokinetic interaction. 

---